Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial.

BACKGROUND: Incidence of difficult endotracheal intubation ranges between 3 and 10%. Bougies have been recommended as an airway adjunct for difficult intubation, but reported success rates are variable. A new generation flexible tip bougie appears promising but was not investigated so far. We therefore compared the new flexible tip with a standard bougie in simulated normal and difficult airway scenarios, and used by experienced anesthesiologists. METHODS: We conducted a observational, randomized, cross-over simulation study. Following standardized training, experienced anesthesiologists performed endotracheal intubation using a Macintosh blade and one of the bougies in six different airway scenarios in a randomized sequence: normal airway, tongue edema, pharyngeal obstruction, manual cervical inline stabilization, cervical collar stabilization, cervical collar stabilization and pharyngeal obstruction. Overall success rate with a maximum of 3 intubation attempts was the primary endpoint. Secondary endpoints included number of intubation attempts, time to intubation and dental compression. RESULTS: Thirty-two anesthesiologist participated in this study between January 2019 and May 2019. Overall success rate was similar for the flexible tip bougie and the standard bougie. The flexible tip bougie tended to need less intubation attempts in more difficult airway scenarios. Time to intubation was less if using the flexible tip bougie compared to the standard bougie. Reduced severity of dental compression was noted for the flexible tip bougie in difficult airway scenarios except cervical collar stabilization. CONCLUSION: In this simulation study of normal and difficult airways scenarios, overall success rate was similar for the flexible tip and standard bougie. Especially in more difficult airway scenarios, less intubation attempts, and less optimization maneuvers were needed if using the flexible tip bougie. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT03733158. 7th November 2018.

Assessment of changes of regional ventilation distribution in the lung tissue depending on the driving pressure applied during high frequency jet ventilation.

BACKGROUND: Electrical impedance tomography (EIT) is a tool to monitor regional ventilation distribution in patient's lungs under general anesthesia. The objective of this study was to assess the regional ventilation distribution using different driving pressures (DP) during high frequency jet ventilation (HFJV). METHODS: Prospective, observational, cross-over study. Patients undergoing rigid bronchoscopy were ventilated HFJV with DP 1.5 and 2.5 atm. Hemodynamic and ventilation parameters, as well as ventilation in different regions of the lungs in percentage of total ventilation, assessed by EIT, were recorded. RESULTS: Thirty-six patients scheduled for elective rigid bronchoscopy. The final analysis included thirty patients. There was no significant difference in systolic, diastolic and mean arterial blood pressure, heart rate, and peripheral saturation between the two groups. Peak inspiratory pressure, mean inspiratory pressure, tidal volume, and minute volume significantly increased in the second, compared to the first intervention group. Furthermore, there were no statistically significant differences between each time profiles in all ROI regions in EIT. CONCLUSIONS: In our study intraoperative EIT was an effective method of functional monitoring of the lungs during HFJV for rigid bronchoscopy procedure. Lower driving pressure was as effective in providing sufficient ventilation distribution through the lungs as the higher driving pressure but characterized by lower airway pressure. TRIAL REGISTRATION: The study was registered on ClinicalTrials.gov under no. NCT02997072 .

Thoracic paravertebral block for postoperative pain management after renal surgery: A randomised controlled trial.

BACKGROUND: Thoracic paravertebral block (ThPVB) combined with general anaesthesia is used in thoracic and general surgery. It provides effective analgesia, reduces surgical stress response and the incidence of chronic postoperative pain. OBJECTIVE: To assess the efficacy of ThPVB in reducing opioid requirements and decreasing the intensity of pain after renal surgery. DESIGN: A randomised, open label study. SETTING: A single university hospital. Study conducted from August 2013 to February 2014. PARTICIPANTS: In total, 68 patients scheduled for elective renal surgery (open nephrectomy or open nephron-sparing surgery). INTERVENTIONS: Preoperative ThPVB with 0.5% bupivacaine combined with general anaesthesia, followed by postoperative oxycodone combined with nonopioid analgesics as rescue drugs. Follow-up period: 48 h. MAIN OUTCOME MEASURES: Total dose of postoperative oxycodone required, pain intensity, occurrence of opioid related adverse events, ThPVB-related adverse events and patient satisfaction. RESULTS: A total of 68 patients were randomised into two groups and, of these, 10 were subsequently excluded from analysis. Patients in group paravertebral block (PVB; n = 27) had general anaesthesia and ThPVB, and those in group general (anaesthesia) (GEN) (n = 31) formed a control group receiving general anaesthesia only. Compared with patients in group GEN, patients who received ThPVB required 39% less i.v. oxycodone over the first 48 h and had less pain at rest (P < 0.01) throughout the first 24 h. Group PVB patients also experienced fewer opioid-related adverse events and were less sedated during the first 12 postoperative hours. Patients in the PVB group had higher satisfaction scores at 48 h compared with the control group. There were no serious adverse events. CONCLUSION: In our study, preoperative ThPVB was an effective part of a multimodal analgesia regimen for reducing opioid consumption and pain intensity. Methods and drugs used in both groups were well tolerated with no serious adverse events. Compared with the control group, patients in the ThPVB group reported increased satisfaction. TRIAL REGISTRATION: Clinical Trials NCT02840526.

Improvement of quality of life after therapeutic plasma exchange in patients with myasthenic crisis.

INTRODUCTION: We sought to evaluate quality of life patients with myasthenic crisis before and after therapeutic plasma exchange. MATERIALS AND METHODS: In our study we conducted an assessment of the quality of life with the use of the questionnaire SF-36, when executed eleven therapeutic plasma exchange. The assessment was made on baseline and after 4 weeks. We also did neurological clinical evaluation before and after TPE. RESULTS: Patients in the study showed significant improvement in quality of life after performed therapeutic plasma exchange. The changes were observed in physical functioning, which confirmed the results of the statistical significance of p<0.05. In the analysis, the assessment of mental functioning not obtained the results of statistical significance, but the results also showed improvement in self-assessment. We observed high correlation between general health and physical mental functioning, between the role limitations due to physical health problems and role limitations due to emotional problems, and general health perception and bodily pain. CONCLUSIONS: Therapeutic plasma exchange significantly improves the quality of life of patients with myasthenia gravis during the crisis.

Cochlear Function Monitoring after Spinal Anesthesia.

BACKGROUND: The aim of the study was to examine the effect of spinal anesthesia on the function of cochlear outer hair cells (OHCs), determined by means of objective distortion product otoacoustic emissions (DPOAE) testing. To the best of our knowledge, our study was the second OAE-based analysis of cochlear function during spinal anesthesia, and the only experiment including such a large group of patients. MATERIAL AND METHODS: The study included 20 patients (18 men and 2 women) subjected to a scheduled uretherorenoscopic lithotripsy with routine spinal anesthesia with 10 mg (2 ml) of 0.5% hyperbaric bupivacaine and 50 µg (1 ml) of fentanyl. The levels of DPOAEs and background noise at 1000-6000 Hz were recorded prior to and immediately after the anesthesia, and on the postoperative day 2. RESULTS: We did not find significant differences between DPOAEs values recorded prior to and immediately after the anesthesia. The only exception pertained to 5652 Hz, at which a significantly higher level of DPOAEs was observed immediately after the anesthesia. The levels of DPOAEs at 2002 Hz and 2380 Hz collected on the postoperative day 2 were significantly higher than the respective baseline values. Irrespective of the frequency and time of testing, we did not find any significant differences between the recorded levels of background noise. CONCLUSIONS: Our findings point to the lack of a detrimental effect of spinal anesthesia on objectively evaluated cochlear function, and thus suggest that this method is safe, even for OHCs, which are extremely susceptible to exogenous and endogenous injuries.

Overview of artificial intelligence in point-of-care ultrasound. New horizons for respiratory system diagnoses.

Throughout the past decades ultrasonography did not prove to be a procedure of choice if regarded as part of the routine bedside examination. The reason was the assumption defining the lungs and the bone structures as impenetrable by ultrasound. Only during the recent several years has the approach to the use of such tool in clinical daily routines changed dramatically to offer so-called point-of-care ultrasonography (POCUS). Both vertical and horizontal artefacts became valuable sources of information about the patient's clinical condition, assisting therefore the medical practitioner in differential diagnosis and monitoring of the patient. What is important is that the information is delivered in real time, and the procedure itself is non-invasive. The next stage marking the progress made in this area of diagnostic imaging is the development of arti-ficial intelligence (AI) based on machine learning algorithms. This article is intended to present the available, innovative solutions of the ultrasound systems, including Smart B-line technology, to ensure automatic identification process, as well as interpretation of B-lines in the given lung area of the examined patient. The article sums up the state of the art in ultrasound artefacts and AI applied in POCUS.

Artificial Intelligence-Supported Ultrasonography in Anesthesiology: Evaluation of a Patient in the Operating Theatre.

Artificial intelligence has now changed regional anesthesia, facilitating, therefore, the application of the regional block under the USG guidance. Innovative technological solutions make it possible to highlight specific anatomical structures in the USG image in real time, as needed for regional block. This contribution presents such technological solutions as U-Net architecture, BPSegData and Nerveblox and the basis for independent assisting systems in the use of regional blocks, e.g., ScanNav Anatomy PNB or the training system NeedleTrainer. The article describes also the systems integrated with the USG devices, such as Mindray SmartNerve or GE cNerve as well as the robotic system Magellan which substantially increases the patient's safety, time needed for the regional block and quality of the procedure. All the solutions presented in this article facilitate the performance of regional blocks by less experienced physicians and appear as an excellent educational tool which, at the same time, improves the availability of the more and more popular regional anesthesia. Will, therefore, artificial intelligence replace physicians in regional block procedures? This seems unlikely. It will, however, assist them in a significant manner, contributing to better effectiveness and improved safety of the patient.

Systematic Review and Meta-Analysis of Efficiency and Safety of Double-Lumen Tube and Bronchial Blocker for One-Lung Ventilation.

One-lung ventilation is also used in some thoracic or cardiac surgery, vascular surgery and oesophageal procedures. We conducted a search of the literature for relevant studies in PubMed, Web of Science, Embase, Scopus and Cochrane Library. The final literature search was performed on 10 December 2022. Primary outcomes included the quality of lung collapse. Secondary outcome measures included: the success of the first intubation attempt, malposition rate, time for device placement, lung collapse and adverse events occurrence. Twenty-five studies with 1636 patients were included. Excellent lung collapse among DLT and BB groups was 72.4% vs. 73.4%, respectively (OR = 1.20; 95%CI: 0.84 to 1.72; p = 0.31). The malposition rate was 25.3% vs. 31.9%, respectively (OR = 0.66; 95%CI: 0.49 to 0.88; p = 0.004). The use of DLT compared to BB was associated with a higher risk of hypoxemia (13.5% vs. 6.0%, respectively; OR = 2.27; 95%CI: 1.14 to 4.49; p = 0.02), hoarseness (25.2% vs. 13.0%; OR = 2.30; 95%CI: 1.39 to 3.82; p = 0.001), sore throat (40.3% vs. 23.3%; OR = 2.30; 95%CI: 1.68 to 3.14; p < 0.001), and bronchus/carina injuries (23.2% vs. 8.4%; OR = 3.45; 95%CI: 1.43 to 8.31; p = 0.006). The studies conducted so far on comparing DLT and BB are ambiguous. In the DLT compared to the BB group, the malposition rate was statistically significantly lower, and time to tube placement and lung collapse was shorter. However, the use of DLT compared to BB can be associated with a higher risk of hypoxemia, hoarseness, sore throat and bronchus/carina injuries. Multicenter randomized trials on larger groups of patients are needed to draw definitive conclusions regarding the superiority of any of these devices.

Non­viral transfection methods optimized for miRNA delivery to human dermal fibroblasts.

Fibroblasts are beneficial model cells for in vitro studies and are frequently used in tissue engineering. A number of transfection reagents have been employed to deliver microRNAs (miRNAs/miRs) into cells for genetic manipulation. The present study aimed to establish an effective method of transient miRNA mimic transfection into human dermal fibroblasts. The experimental conditions included three different methods: Physical/mechanical nucleofection, and two lipid­based methods, Viromer® Blue and INTERFERin®. To evaluate the impact of these methods, cell viability and cytotoxicity assays were performed. The silencing effect of miR­302b­3p was revealed to alter the expression levels of its target gene carnitine O­octanoyltransferase (CROT) by reverse transcription­quantitative PCR. The present study showed that all selected non­viral transient transfection systems exhibited good efficiency. It was also confirmed that nucleofection, for which a 21.4­fold decrease in the expression of the CROT gene was observed 4 h after 50 nM hsa­miR­302b­3p transfection, was the most effective method. However, these results indicated that lipid­based reagents can maintain the silencing effect of miRNAs up to 72 h after transfection. In summary, these results indicated that nucleofection may be the optimal method for the transport of small miRNA mimics. However, lipid­based methods allow for the use of lower concentrations of miRNA and maintain longer­lasting effects.

Cardiac Arrest after Small Doses Ropivacaine: Local Anesthetic Systemic Toxicity in the Course of Continuous Femoral Nerve Blockade.

BACKGROUND: The paper presents a case report of an episode of local anesthetic systemic toxicity (LAST) with cardiac arrest after continuous femoral nerve blockade. CASE REPORT: A 74-year-old patient burdened with hypertension and osteoarthritis underwent elective total knee replacement surgery. After surgery, a continuous femoral nerve blockade was performed and an infusion of a local anesthetic (LA) was started using an elastomeric pump. Five hours after surgery, the patient had an episode of generalized seizures followed by cardiac arrest. After resuscitation, spontaneous circulation was restored. In the treatment, 20% lipid emulsion was used. On day two of the ICU stay, the patient was fully cardiovascularly and respiratorily stable without neurological deficits and was discharged to the orthopedic department to continue treatment. CONCLUSION: Systemic toxicity of LA is a serious and potentially fatal complication of the use of LA in clinical practice. It should be noted that in nearly 40% of patients, LAST deviates from the classic and typical course and may have an atypical manifestation, and the first symptoms may appear with a long delay, especially when continuous blockades are used. Therefore, the proper supervision of the patient and the developed procedure in the event of LAST is undoubtedly important here.

Fascial plane blocks for breast surgery - current state of knowledge.

Breast surgeries belong to the most frequently performed procedures and are often associated with a high intensity of pain in the postoperative period. Regional anesthesia techniques, and paravertebral block, have been the gold standard of postoperative pain management for major breast cancer surgeries. In recent years, the development of new techniques of regional anesthesiology, which is due to the extensive implementation of ultrasound imaging, has enabled the use of a number of new blockades. The "new players" in regional anesthesiology include numerous fascial plane blocks. Fascial plane blocks are often technically easier and less invasive compared to, for example, paravertebral blockade. The core mechanism of action in fascial blocks consists in blocking the nerve structures that supply a certain area of the trunk after deposition of local anesthetic (LA) within the fascial and fasciomuscular compartments. In addition to direct nerve blockade, there are other potential mechanisms of analgesia such as systemic effects. This idea differs from the traditional concept of nerve and plexus blocks, but it should be remembered that the final effect of a fascial plane block and its extent can be extremely variable across individual cases. According to the current state of knowledge, an alternative to paravertebral blockade may be PECS blockade. The available options also include erector spinae plane block (ESPB) and serratus plane block (SPB), however their recommendation in breast surgery requires more extensive scientific evidence.

Young convalescent COVID-19 pneumonia with extensive pneumomediastinum emphysema: Case report.

The development of the SARS-CoV-2 pandemic caused a common appearance of severe pulmonary complications, rarely seen as a result of the other infections. These are pneumothorax, pneumomediastinum, emphysematous bullae, cavitary lung lesions, or subcutaneous emphysema. Their formation is influenced by both-the natural course of the disease and the treatment strategy adopted.

Opioid-Free Anaesthesia Effectiveness in Thoracic Surgery-Objective Measurement with a Skin Conductance Algesimeter: A Randomized Controlled Trial.

BACKGROUND: Chest surgery is associated with significant pain, and potent opioid medications are the primary medications used for pain relief. Opioid-free anaesthesia (OFA) combined with regional anaesthesia is promoted as an alternative in patients with an opioid contraindication. METHODS: Objective: To assess the efficacy of OFA combined with a paravertebral block in pain treatment during video-assisted thoracic surgery. DESIGN: A randomized, open-label study. SETTING: A single university hospital between December 2015 and March 2018. PARTICIPANTS: Sixty-six patients scheduled for elective video-assisted thoracic surgery were randomized into two groups. Of these, 16 were subsequently excluded from the analysis. INTERVENTIONS: OFA combined with a paravertebral block with 0.5% bupivacaine in the OFA group; typical general anaesthesia with opioids in the control group. MAIN OUTCOME MEASURES: Intraoperative nociceptive intensity measured with a skin conductance algesimeter (SCA) and traditional intraoperative monitoring. RESULTS: Higher mean blood pressure was observed in the control group before induction and during intubation (p = 0.0189 and p = 0.0095). During chest opening and pleural drainage, higher SCA indications were obtained in the control group (p = 0.0036 and p = 0.0253), while in the OFA group, the SCA values were higher during intubation (p = 0.0325). SCA during surgery showed more stable values in the OFA group. Pearson analysis revealed a positive correlation between the SCA indications and mean blood pressure in both groups. CONCLUSIONS: OFA combined with a paravertebral block provides effective nociception control during video-assisted thoracic surgery and can be an alternative for general anaesthesia with opioids. OFA provides a stable nociception response during general anaesthesia, as measured by SCA.

A randomized comparison between the VivaSight double-lumen tube and standard double-lumen tube intubation in thoracic surgery patients.

Background: Thoracic surgery often demands separation of ventilation between the lungs. It is achieved with double-lumen tubes (DLTs), video double-lumen tubes (VDLTs) or bronchial blockers. We tested the hypothesis that intubation with the VivaSight double-lumen tube would be easier and faster than with a standard DLT. Methods: Seventy-one adult patients undergoing thoracic procedures that required general anaesthesia and one-lung ventilation (OLV) were enrolled in this randomized, prospective study. Patients were randomly assigned to procedure of intubation with a standard DLT or VDLT. The collected data included: patients' demographics, surgery information, anthropometric tests used for difficult intubation prediction, specifics of intubation procedure, tube placement, fiberoptic bronchoscopy (FOB) use, lung separation, trachea temperature, and reported complications of intubation. Results: For DLTs compared to video-double lumen tubes, intubation time was significantly longer (125 vs. 44 s; P<0.001), intubation graded harder (P<0.05) and FOB use was more prevalent [8 (20.5%) vs. 0; P<0.05]. Conclusions: The use of VDLTs when compared with standard-double lumen tubes offers reduced intubation time and is relatively easier. Also, the reduced need for fibreoptic bronchoscopy may improve the cost-effectiveness of VDLT use. In addition, constant visualization of the airways during the procedure allows to quickly correct or even prevent the tube malposition. Trial Registration: ClinicalTrials.gov Identifier: NCT04101734.

Flow-controlled ventilation - a new and promising method of ventilation presented with a review of the literature.

Substantial efforts have been undertaken to identify and minimise factors responsible for the development of ventilator-induced lung injury. A novel approach to this problem addresses energy dissipated in lung tissue during the breathing cycle as one of the key problems. Flow-controlled ventilation is a new modality of mechanical ventilation based on a constant flow during both inspiration and expiration. This review aims to evaluate the current evidence available regarding flow-controlled ventilation. Lastly, three cases of flow-controlled ventilation application are presented: ventilation with a small lumen tube during tracheal resection, one-lung ventilation during thoracoscopic lobectomy, and ventilation of a critically ill patient with acute respiratory distress syndrome in an intensive care unit setting.

Epidural and opioid analgesia following the Nuss procedure.

BACKGROUND: Parents have the right to decide on behalf of their children and deny consent to regional anaesthesia. The investigators decided to investigate quality of postoperative analgesia in adolescents undergoing epidural and opioid analgesia following the Nuss procedure. material/methods: The study subjects were 61 adolescents aged 11-18 years who underwent pectus excavatum repair with the Nuss procedure. Patients were divided into epidural (n=41) and opioid (n=20) groups, depending on their parents' consent to epidural catheter insertion. Intraoperatively, 0.5% epidural ropivacaine with fentanyl or intermittent intravenous injections of fentanyl were used. Postoperative analgesia was achieved with either epidural infusion of 0.1% ropivacaine with fentanyl, or subcutaneous morphine via an intraoperatively inserted "butterfly" cannula. Additionally, both groups received metamizol and paracetamol. Primary outcome variables were postoperative pain scores (Numeric Rating Scale and Prince Henry Hospital Pain Score). Secondary outcome variables included hemodynamic parameters, additional analgesia and side effects. RESULTS: Heart rate and blood pressure values in the postoperative period were significantly higher in the opioid group. Pain scores requiring intervention were noted almost exclusively in the opioid group. CONCLUSIONS: Denial of parental consent to epidural analgesia following the Nuss procedure results in significantly worse control of postoperative pain. Our data may be useful when discussing with parents the available anaesthetic techniques for exceptionally painful procedures.

Effectiveness of Fascia Iliaca Compartment Block after Elective Total Hip Replacement: A Prospective, Randomized, Controlled Study.

OBJECTIVE: An assessment of the feasibility of fascia iliaca compartment block (FICB) combined with nonopioid analgesics and patient controlled analgesia (PCA), oxycodone, in the perioperative anaesthetic management for elective total hip replacement (THR). DESIGN: A randomised, single-center, open-label study. SETTING: A single hospital. The study was conducted from October 2018 to May 2019. PARTICIPANTS: In total, 109 patients were scheduled for elective total hip replacement. INTERVENTIONS: Postoperative FICB with 0.375% ropivacaine in conjunction with nonopioid analgesics (paracetamol, metamizole, and pregabalin) and oxycodone as rescue analgesia. MEASUREMENTS: Pain intensity was measured using the Numeric Pain Rating Scale (NRS) at rest and during rehabilitation, the total dose of postoperative oxycodone required, the occurrence of opioid-related adverse events, patient hospitalisation time, and level of satisfaction. Follow-up period: 48 h. MAIN RESULTS: A total of 109 patients were randomised into two groups and, of these, 9 were subsequently excluded from the analysis (three conversions to general anaesthesia, two failures to perform FICB, four failures to use the PCA pump). Patients in the FICB group received standard intravenous analgesia with FICB, and those in the control group were managed with standard intravenous analgesia only. Pain level measured with NRS was significantly lower at rest and during rehabilitation in the FICB group. Oxycodone use in the first 48 h was significantly higher in the control group (p < 0.001); additionally, the time to the first dose of rescue analgesia was significantly shorter (p < 0.001). In the control group, there was a higher rate of side effects and a significantly longer hospitalisation time (p < 0.001). Similarly, higher satisfaction with the applied analgesic treatment was noted in the FICB group. CONCLUSIONS: FICB in elective THR treatments is an effective form of analgesia, which reduces the need for opioids, the number of complications, the length of hospitalisation, and which ensures a high level of patient satisfaction with the analgesic treatment used. TRIAL REGISTRATION: ClinicalTrials.gov No. NCT04690647.

Guidelines of the Polish Society of Anaesthesiology and Intensive Therapy regarding prevention of inadvertent intraoperative hypothermia.

Core body temperature is strictly regulated (± 0.2 °C) and coordinated at the level of central nervous system located in the hypothalamus via several protective effector mechanisms that prevent overcooling and overheating. The central regulation permits both circadian and monthly variations of even 1°C; under normal conditions, however, the activation of effective protective mechanisms prevents even the slightest overcooling and core temperature elevation at any moment of the day.

Stress responses in high-fidelity simulation among anesthesiology students.

Simulation sessions can produce high-fidelity emergency situations that facilitate the learning process. These sessions may also generate a complex stress response in the learners. This prospective observational study assessed psychological, physiological, immunological, and humoral levels of stress during high-fidelity simulation training. Fifty-six undergraduate medicine students who took part in a medical simulation session were assigned team roles (physician, nurse or assistant). Subsequently, each participant was assessed before the scenario (T0), after the procedure (T1), and two hours later (T2). Psychological stress and anxiety were measured at T0 and T1, using the State-Trait Anxiety Inventory (STAI) and Dundee Stress State Questionnaire (DSSQ). Cortisol, testosterone, secretory immunoglobulin class A (sIgA), alpha-amylase, and oxygen saturation level were measured at T0, T1, and T2, as was the physiological response indicated by heart rate (HR) and blood pressure (BP). It was found that the onset of task performance was related to increased anticipatory worry and higher oxygen saturation. The participants reported decreased worry, followed by increased emotional distress after the simulation training (T1). Participants trait anxiety predicted the intensity of worry, distress and task engagement. In contrast, no clear relationships were found between trait anxiety and biological stress markers. Testosterone levels were growing significantly in each phase of measurement, while physiological responses (BP, HR) increased at T1 and declined at T2. The levels of stress markers varied depending on the assigned roles; however, the trajectories of responses were similar among all team members. No evidence for prolonged cortisol response (T1, T2) was found based on psychological stress at the onset of simulation (T0). Regression analysis followed by receiver operating characteristics analyses showed uncertain evidence that initial state anxiety and worry predicted the levels of sIgA. Medical students are relatively resilient in terms of stress responses to medical simulation. The observed stress patterns and interrelationships between its psychological, physiological, hormonal, and immunological markers are discussed in accordance with theoretical concepts, previous research work, and further recommendations.

An assessment of the effectiveness of regional analgesia after VATS measured by an objective method for assessing testosterone, cortisol, α-amylase, sIgA, and ß-endorphin levels - a randomised controlled trial.

INTRODUCTION: Thoracic surgeries are associated with intense postoperative pain. General opioid analgesia is still the main anaesthetic method. Due to the large number of opioid-induced side effects, alternative methods of pain relief are sought. One of them is the use of balanced analgesia, which consists of regional analgesia, non-opioid painkillers, and small doses of opioids. MATERIAL AND METHODS: The objective of this study was to assess the effectiveness of preoperative thoracic paravertebral block (ThPVB) in the treatment of postoperative pain after video-assisted thoracic surgery (VATS) by measuring hormone levels in blood serum or saliva. It was a randomised, open-label study conducted in a single university hospital setting between May 2018 and September 2019. In total, 119 patients were scheduled for elective video-assisted thoracic surgery. Performed interventions included: preoperative thoracic paravertebral block with 0.5% bupivacaine, followed by postoperative oxycodone combined with nonopioid analgesics. Follow-up period comprised first 24 hours and one, two, and six months after surgery. Main outcomes were measured by pain intensity assessed using the Numerical Rating Scale (NRS) and the levels of the following hormones: testosterone, cortisol, α-amylase activity, sIgA, and ß-endorphin. RESULTS: A total of 119 patients were randomised into two groups and, of these, 49 were subsequently excluded from the analysis. The final analysis included 37 patients from the study group and 33 from the control group. There were no statistically significant differences in the analysed parameters the relative change T1-T0. There was a tendency towards statistical significance in the relative change T2-T0 in testosterone levels. At rest, no statistically significant differences were found between groups and time in the percentage of patients with NRS ≥ 1. During cough, the percentage of patients with NRS ≥ 1 was higher at T1 and T2 time points in the ThPVB group. Of the factors considered, only α-amylase levels statistically significantly increased the chance for higher NRS score after a month [OR = 1.013; 95% PU: 1.001-1.025; p < 0.01]. CONCLUSIONS: ThPVB is effective and safe for patients undergoing VATS. It can be an effective alternative for general anaesthesia using high doses of opioids.